• StartUps

Despite having a longing to start something on his own with visible social impact, Kolkata-bred Dr. Shantanu Chattopadhyay, Founder and Managing Director, NationWide Primary Healthcare Services Pvt. Ltd., took his time before he leapt. After working in a teaching hospital in London, he pursued an MBA to help him ‘think laterally,’ and joined INSEAD in 2003. Post B-school, he spent three years at Johnson & Johnson in sales and marketing; then chose to join a startup to get a feel of the entrepreneurial way of things. This was Indegene Lifesystems, a life sciences KPO, where he built a new business vertical from scratch after joining them in 2007.
By now he had laid the foundations to venture out, having experienced both structured and unstructured work environments. Along with Dr. Shantanu Rahman, Founder and Medical Director, NationWide, a batchmate from medical school, he launched NationWide, a healthcare startup in March 2010 to replicate the functioning of a general physician.

Deciding factors
The opportunity present was the result of a handful of factors. Three decades ago primary care was delivered by the family doctor, a patient’s first point of contact. “The advantage he had over time is that he knew you and your family well, building a level of trust in the process,” he says. Today, from a professional standpoint, it’s gone out of fashion as doctors aspire to become specialists. A survey conducted by the founders saw that only two of 100 medical students said they would consider becoming a general physician, compared to one out of two in the U.K.
Then the financial angle came into play: general practitioners rely on their own clinics, and investment costs range from Rs.10 lakh-Rs.15 lakh, albeit with slow returns. “There’s a long waiting cycle till people adopt them, most doctors don’t earn even 5-10 percent for the first six-eight months,” he mentions. Plus, establishing yourself in this line takes a good three-five years. “General practitioners are seen as failures in society and within the medical community. Plus, they don’t have the time or support to keep abreast of the latest advancements. Organizing an unorganized sector was an opportunity,” explains the entrepreneur. The startup’s initial idea was to help other general practitioners provide better service and the founders began the venture on a virtual model. It involved a virtual doctor to keep patient records, consult them over the phone and coordinate specialists. “But we soon realized this model won’t work,” says Chattopadhyay.

A different business model
It didn’t take long to figure out a feasible business model. “We needed a personal physician attached to each patient,” says Chattopadhyay. From April-December 2010, the founders ran a proof of concept supported with angel funding, and spread the word through their personal and professional networks. It was not open to general public at that time. What started as a one-office set up with Rahman consulting patients on a membership basis, today runs on the back of three full-service clinics and four satellite clinics in Bengaluru, after raking in a second round of angel funding. In retrospect, the founders feel they lost seven-eight months running it from an office. “A retail business must start from the shop floor, not an office,” rues Chattopadhyay.
NationWide has also created a separate entity for paediatric care and entered into a strategic relation with Neo Natal Care Research Institute which gives them access to paediatricians. “Since the requirement here falls in evenings only, doctors don’t need to be on full-time roll,” he explains.

Potential opportunity
Raghuveer Tarra, Senior Vice President and General Manager, Sling Media, invested Rs.1 crore as a first angel on the back of its business model that addressed the need in primary healthcare services segment in India. “It was a no-brainer for me to be convinced about the potential opportunity,” says Tarra.

Model changes
The company has more differentiators. “We realized that patients are looking for convenience,” he explains. So, NationWide not only changed the model to clinics offering complete day-to-day medical requirements, but the initial practice of referring patients to diagnostic clinics for lab tests was done away with since customers weren’t happy with the level of service.
Instead it’s got its own laboratory as a blood collection unit from where it sends samples out to third party vendors. Patients can either sign up for annual membership plans, all of which are designed based on different customer needs (including home-visits in some plans) or can walk-in and pay on a per consultation basis.
“Revenue growth on a per clinic basis serving the needs of retail customers (B2C) and corporate customers (B2B) further strengthens their business model,” affirms Tarra.

Customer-speak
Aruna Sakhuja, a 68-year-old, lives and works alone in Bengaluru. After almost giving up her search for a general practitioner who could come home, she read about NationWide in a newspaper and signed up as a member in 2010, purely on faith. Sakhuja gave us positive feedback. “They are economically-priced and my mental satisfaction is much higher than the money paid,” she states.

New ideas
Though still not functioning on full capacity, each clinic will eventually comprise of four general practitioners, one paediatrician and two nurses. “We plan to have a pharmacy and will soon outsource it to a reputed player,” adds Chattopadhyay. On the professional side, NationWide has created job opportunities for general practitioners as full-time salaried staff. Unlike the West, general practice is not a well-established profession and India lags behind with necessary training too.
In countries like the U.S. and the U.K, general practitioners are required to undergo a residency program of at least three years which gives them a degree before they can practice. “This is where an organization like ours helps,” highlights Chattopadhyay. Every Tuesday, its clinics are shut and the time is used to train doctors for continuous medical update.

Recruitment policy
The firm’s recruitment strategy didn’t target fresh medical school graduates, but those returning to India with a minimum of two-five years’ work experience. Dr. Jaya Bajaj, Head, Medical Education and Training and practicing doctor at NationWide, is one such case. In January 2011, Bajaj moved back to India with her husband, after practicing in a community medical center in the U.S. She chanced upon Chattopadhyay’s profile on LinkedIn and was soon on the company’s payrolls. “We are well-paid here, the salary is competitive and we’re given performance bonuses too,” she says.

What the future holds
Bhupen Shah, COO and VP Engineering, Sling Media, angel investor since December 2010, feels the need for more senior management as the business scales up.
“Retail operational and marketing experience will further strengthen the executive team,” he says.
The challenges of a retail business in India, Chattopadhyay says, are primarily around rent to remuneration ratio. “Adoption will always lag behind expectation,” he says.
Nevertheless, heady on expanding, NationWide’s plans include 20 full service clinics in Bengaluru in the next 18 months. It also plans to enter the Gurgaon and Kolkata markets in 2012 and is in the process of negotiating with VCs to scale up the business.

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NationWide Primary Healthcare Services, Shantanu Chattopadhyay